Q: I am a 61 years old male underwent a bypass (left internal mammary artery, LIMA) surgery 14 months back. After surgery, I am experiencing heaviness in the chest. I was informed that the pain subsides after a couple of months. Why am I suffering from heaviness in the chest? How to manage it?

A:Chest pain could occur because of multiple causes and only a small percentage of them arise from the heart. However, because heart pain is the most serious one, the dictum is that every chest pain should be treated as coming from the heart, unless and until proved otherwise, but in generic terms majority of chest pains do not come from the heart and may arise either from the muscles or bones & joints of the chest wall or from the food pipe and the stomach. Even underlying lung and its covering layers can give rise to chest pain. So to pin point the cause of pain through remote consultation internet would be impossible.

Normal coronary arteries on angiogram rules out blockage in the major arteries of the heart. However, sometimes smaller arteries, which are microscopic and not visible to the naked eye and therefore not seen on the angiogram, may have blockages. Also the inner lining of these blood vessels may be at fault (endothelial dysfunction) and can some time lead to sluggish circulation in the micro-circulation of the heart and produce chest pain (called Syndrome X). However, for all this, you need to consult a cardiologist who alone can give you a firm answer as to the cause of the chest pain and any treatment that he needs to take. This is also decided keeping in mind the risk profile of the individual - the presence of diabetes or hypertension, family history, history of tobacco intake etc. So I suggest that you consult your cardiologist on this matter. As an afterthought, I notice that the weight reported is 95 kg, which is significant obesity and he should make an effort to reduce his weight, which may help matters tremendously.